Paragon removes the smoke and mirrors from the healthcare planning process by identifying all plan cost and to help you understand how each component affects your bottom line.
Claim cost component – medical expenditures incurred by employees
  • Doctors
  • Hospital
  • RX
  • Other health care facilities and practitioners

Paragon provides realistic projections of expected paid claims in each claim category so that your budget can be maintained throughout the plan year.
Reserves
  • IBNR – incurred but not reported claim cost
  • Contingency reserves – unanticipated future costs

Paragon projects reserves that should be disclosed, but not necessarily funded resulting in considerable savings over traditionally insured plans..
Reinsurance – Stop-Loss Coverage

Specific Stop-Loss
Limits individual claims

  • Incurred and paid within the plan year
  • Paid during the plan year
  • Paid with run off liability

Aggregate Stop-Loss
Limits all plan claims during plan year

  • Incurred and paid
  • Incurred and paid with run-off liability

Paragon not only advises and places your reinsurance; we recommend the “right coverage” for your plan.
Administrative and Plan Management

TPA services
Vendor Services

  • Medical Network selection and management
  • PBM selection and management
  • Wellness program management

Communication, compliance and documentation services


Paragon is full service. We handle all aspects of your plan thereby reducing cost. Our services are generally 30% less than traditional insurance administrative expense due to our lower overhead and not-for-profit ownership.
Self-Funding Cost Savings vs Fully Insured Plan

Insurance company overhead

  • Shareholder returns

Profits/Dividends/Pressures from Wall Street analyst

  • Executive Compensation
  • Taxes
  • Income taxes on profits
  • State Premium taxes assessed and passed on to policyholders

Bureaucratic inefficiencies
Dealing with multiple departments and multiple people

  • Will they value you as a customer?

Cost shifting between company business lines

  • Subsidizing unprofitable lines of coverage
  • Individual health insurance
  • Small group products
  • Medicare administration

Paragon helps you understand the cost differences in an honest – straight-forward manner
Plan Flexibility

Plan design considerations

Same plan for all employees regardless of location: or different plans to satisfy markets and contracts that vary by location

Eliminate state mandated benefits

  • Cost considerations
  • Moral and ethical considerations

Consumer driven concepts

With and without HSAs & wellness initiatives

Contribution structures to drive plan design results

Incentive and disincentive pricing of plan options to drive results

Dependent contributions and opt-out strategies reduce adverse selection


Paragon knows plan design. We can help you meet your objectives, metrics and accountability.
Health Improvement and Participant Motivation

Wellness Programs

Passive
Education and awareness

Aggressive

Biometric screening
Mandatory programs
Weight loss
Smoking cessation

Disease specific

Diabetes
Heart disease

Participant Contributions

Plan design direction
Behavioral direction
Offset cost and non-participation in programs

Trends-Reality of the Self-Funded Industry

1. Major Trends Health Care Industry

Consumer Directed Health Care Plans.

High Deductible Plans where the employer funds HRA based on employee participation in Health Improvement Plan.

Health Improvement Plans.
Only way to reduce cost is to reduce claims via:
  • Reduced obesity
  • Reduced smoking
  • Reduce chronic disease
Narrow Networks
Reduced medical practitioners to drive more members and reduce
incremental cost of each encounter

Primary care initiatives
Direct Primary Care Plans
In-house clinics
Near facility clinics

ACOs (Accountable Care Organizations)
ObamaCare incentives to develop linked providers in a shared data network

2. ACA considerations

The Mandate - Pay or play
  • Continue to sponsor health plan or pay penalty/tax and offload participants to exchanges
  • $2000 for each FTE less the first 30
Determination of large employer
  • Over 50 full-time employees
Plan design limitations
Minimum Value
Affordability test
  • 9.5% of household income
  • 400% of FPL (federal poverty limits)
Eligibility Rule
  • 90 day waiting period maximum
Coverage for Part-Time employees
  • 30 hours or more per week
  • To determine large ER status over 50 part-timers are considered by aggregate number of PT hours divided by 120
Contribution requirements
  • EE contribution must not exceed 9.5% of Household income or ER pays $3000 annual penalty
Taxes for “Cadillac Plan” in 2018
  • Plans exceeding $10,200 for individuals
  • $27,500 for other plans (dependents)
  • - 40% tax of cost of plans
    - Plan administrator collects and pays tax

And Why Choose Paragon?

One of our most important goals is to ensure you trust and are confident in your decision for selecting Paragon to help guide your self-funded healthcare plan! These are some of the reasons why you will have the freedom of tranquility and ability to relax as you know that we are working arduously to ensure your self-funded healthcare plan….is planned better!
  • Creative and cost conscious plan design assistance – we know what works.
  • Health improvement and participant motivation programs that result in lower claim cost.
  • Member contribution council to improve participation and reduce adverse selection.
  • Governmental compliance and regulatory review is at the forefront of our service commitment.
  • Written plan documents, including SPD’s, COBRA & HIPAA communications are provided as a standard feature.
  • Plan transition from fully insured to self-funded.
  • Enrollment communications and technology tools to aid participation and ongoing eligibility management.
  • Fiduciary assistance to minimize liability exposures.
  • Long standing relationships with stop loss insurance companies, PBM’s and wellness vendors brings lower cost and problem resolution to our clients.
  • Our leaders participate with industry trade groups and associations to respond to and shape regulatory framework.